Implementation and utilisation of community-based mortality surveillance: a case study from Chad

Area of Science:

• Public Health
• Epidemiology
• Humanitarian Medicine

Background:

• Prospective surveillance is crucial for measuring death rates in humanitarian emergencies.
• Optimal implementation and data utilization of mortality surveillance by aid agencies require further investigation.
• This case study examines Médecins Sans Frontières' (MSF) mortality surveillance in eastern Chad.

Purpose of the Study:

• To describe and analyze MSF's community-based mortality surveillance system.
• To evaluate trends in mortality data from 2004-2008.
• To assess the utilization of surveillance data for operational response.

Main Methods:

• Case study involving 5 MSF sites: 2 refugee camps and 3 internally displaced persons (IDP) camps.
• Data collection through key informant interviews.
• Systematic review of MSF operational reports (2004-2008).

Main Results:

• Mortality data collected by community health workers (CHWs) generally showed a progressive decrease.
• Crude Death Rates (CDR) and Under-5 Death Rates (U5DR) declined significantly across all studied sites.
• An acute mortality spike in Kerfi IDP camp in July 2008 briefly exceeded emergency thresholds before rapidly declining.

Conclusions:

• Mortality data were regularly used for health monitoring and advocacy.
• Key lessons include the need for improved population estimates, standardized reporting, a flexible data collection model, and enhanced CHW supervision.
• The community-based surveillance model is adaptable for humanitarian agencies, emphasizing routine data dissemination and improved operational utilization.